The document discusses jail diversion programs that aim to divert individuals with mental illness from incarceration and instead provide community-based treatment services. It provides an overview of the problem of high rates of mental illness in jails, and describes the comprehensive diversion model implemented in Bexar County, Texas. This model involves collaboration between multiple agencies and has intervention points at various stages of the criminal justice system. It also outlines the benefits of diversion programs, such as reduced costs, fewer mentally ill individuals in jails, and increased public safety.

1. Jail Diversion Together We Stand, Educating Our Vision for the Future! Coastal Bend Rural Health Partnership October 8-9, 2010 Texas A&M University – Kingsville, Texas Gilbert R.Gonzales Director, Communications and Diversion Initiatives The Center for Health Care Services www.chcsbc.org http://www.diversioninitiatives.net

3. The Problem

4. Bexar County Safety Net

5. How the Program Works

7. CRAZYby Pete Earley “Wherever I go, I take myself with me, and that always spoils it.” Susan Sheeham

8. History of Mental Illness in America Lobotomies were introduced in 1945 by sticking an ice pick into the frontal lobes of the brain. The invention received a Nobel Prize.

9. History of Mental Illness in America Early 1800’s - A Reverend found an inmate in Boston Jail in a closet for 9 years. He had not broken any laws. Historical treatment options included: Electroshock (ECT) Insulin injections Metrazol (induced seizures) Hydrotherapy (wet sheets and continuous baths) Fever therapy (injecting patients with disease in order to cause a fever)

10. “If you ask most people today where the mentally ill are in our society, they will tell you they’re in state mental hospitals. They’re wrong…they are in our jails and prisons.”Judge Steven Leifman Eleventh Judicial Circuit Miami, Florida

11. The Problem The American Jail Association estimates that over 650,000 bookings each year involve persons with mental illness. The national average in jail for this population is 16% and 64% arrested for public acts of bizarreness or non-violent minor charges. Inmates with mental illness serve an average of 15 months longer for the same crime, compared to other prisoners.

12. “ If you’ve seen ONE jail diversion program, you’ve seen ONE jail diversion program “

13. The Problem Criminalization of Mentally Ill Inappropriate Cost to Society 20% + in jail Increase use of emergency rooms Homelessness Public Safety Net Consumers at risk Law Enforcement at risk Public at risk

14. If No Programs Are In Place Continued Increase/Overcrowding in Jail Population Continued Increase/Overcrowding in Prison Population Increased and Inappropriate Use of Emergency Rooms

15. Collaboration: It’s an unnatural act between… …two or more unconsenting adults.

16. A mouse, a cat and a dog. http://www.youtube.com/watch?v=D85yrIgA4Nk

17. Strategies for Success Don’t let them go to jail in the first place Diversion in all appropriate settings Set up: Primary Diversion/Intervention Pre booking services Cross match of jail population In jail screening/services Secondary Diversion/Intervention Post booking services Intensive outpatient treatment for probation/parole (Genesis) Residential MH services (MIOF) Continuity of Care Intensive ongoing case management Timely updates to Judges MH/Judicial joint staffing

18. How We Started Community Partnership The Jail Diversion Planning & Advisory Committee City of San Antonio Bexar County University Hospital District Private Hospitals San Antonio State Hospital Law Enforcement Criminal/Civil Courts Advocacy – NAMI Consumers Mental Health Partners The Jail Diversion Over-sight Committee Community Medical Directors Roundtable Private Sponsorship Aztrazeneca

19. The Model The Bexar County Jail Diversion Model is a comprehensive, coordinated delivery network which is tasked with identification, diversion from incarceration and treatment of the mentally ill for persons who are placed or who are about to be placed within the criminal justice system. The model is symptom based and is designed to cover 46 specific intervention points within the mental health/criminal justice system.

21. Crisis Care Center

22. CIT/DMOT

23. Jail and Juvenile Detention

24. Statewide CARE MatchDynamic Information Exchange

25. The Diversion Process Point of Contact with Law Enforcement CIT/Deputy Mobile Outreach Team Emergency Transport to Hospital 24/7 Crisis Services *Pre-Arrest Diversion Referrals to Community Providers Magistrate Court Post-Booking Diversion Arrested Bexar County Jail Community-based Wraparound Care Pre-Trial Diversion Genesis Probation, Incarceration, Parole Treatment in lieu of Incarceration Residential Respite

26. Bexar County Public Safety Net Crisis Care Center Jail Diversion Initiatives The Restoration Center

29. Medical Clearance

30. Psychiatric Services

34. Jail Diversion Initiatives Pre-Trial Services Mental Health Bond Involuntary Outpatient Commitment Genesis – Manos Programs Parole & Probation Referrals MIOF Program Intensive 90 day residential probation Court Ordered Program Palo Alto Forensic ACT Team 24/7 Intensive psychiatric services

35. Show me the DATA !!!

38. Emergency Room Utilization (Medical Clearance) Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center. 40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year) X $1545 Cost Savings relative to ER Utilization $4,709,160 Source: Jean R. Setzer, Ph.D., University Health System

39. Combined CCC and Restoration Documented and Immediate Cost Avoidance

42. Increased public safety

44. Violence and victimization is reduced

45. Costs incurred by taxpayers when a person with mental illness is arrested, incarcerated, and/or hospitalized is addressed

46. Thank you ! www.chcsbc.org Leon Evans, Executive Director The Center for Health Care Services San Antonio, Texas For additional information please contact: Gilbert Gonzales Email: ggonzales@chcsbc.org Blog http://www.diversioninitiatives.net